| NPI | 1154183838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1156510) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 941802) |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2024-04-09 |